Should Social Workers Use the DSM-5

Among the 500,000 mental health professionals in the US who will use the DSM 5, the 250,000 social workers (Center for Health Workforce Studies, 2006) comprise by far the largest group, followed by 120,000 mental health counselors (American Counseling Association, 2011), 93,000 psychologists (American Psychological Association, 2011), and 38,000 psychiatrists (American Psychiatric Association, 2011).

For many social workers, DSM is a daily companion having a dramatic impact on how they assess patients, make a diagnosis, and plan treatment. The American Psychiatric Association (APA) is the sole group that revises the DSM, despite the fact that psychiatrists account for only 7% of all mental health professionals and only 10% of all physicians who prescribe psychotropic medications.

In the past, social workers and other mental health professionals have relied on APA and the DSM for guidance in the diagnosis process. And while previous DSMs have failed to achieve universal admiration, none has failed to achieve universal acceptance.

Certainly, there have been numerous controversies about the overall reliability of the system; its seeming tilt toward a biological approach; the relative lack of participation of professional groups other than psychiatry; and the inclusion and/or definition of particular mental disorders. But no one questioned whether DSM should be used at all or suggested that there was an alternative way forward.

DSM-5 has changed the landscape by being so closed in its process, flawed in its execution, unrealistically ambitious in its hopes, and dangerous in its product that many mental health professionals may choose not to use it.

The work on DSM-5 has been secretive, geared less to protecting the public trust than to generating publishing profits for the American Psychiatric Association (APA). Participants were forced to sign confidentiality agreements, the scientific review has been conducted behind closed doors, and APA rebuffed a petition endorsed by fifty-one professional organizations for an open and independent review of its suggestions.

Everything about DSM 5 was done in a disorganized way: constant missing deadlines, inconsistent methods for conducting literature reviews, poor research design for the field trials, and finally the cancellation of the crucial quality control step because time was running out (Frances, 2010, 2012; Jones, 2012). This process has not inspired confidence.

The DSM-5 product is frightening in its over-inclusiveness- with lowered diagnostic thresholds across a number of disorders and the addition of many new “subthreshold” disorders. The changes blur the boundaries between pathology and normal behavior, resulting in increased overall prevalence rates of mental disorders and many new false epidemics. Millions of normal people will be mislabeled as mentally ill and subjected to stigma and to unnecessary treatment and testing.

This will exacerbate what is already a serious problem in the United States – the medicalization of normal behavior. We are already in the midst of a national glut of excessive medication use causing harmful and unnecessary side effects and complications. What can social workers do if they don’t like the DSM-5 final product? Ignore it.

There is nothing official about DSM 5. There are no DSM 5 codes- all codes used for reimbursement are ICD-9-CM codes which are available for free on the internet. You can bypass DSM-5 altogether and instead use the readily available diagnostic codes of the International Classification of Diseases (ICD). You can also continue to use DSM-IV diagnostic codes until oct 2014 when they will be replaced by ICD-10-CM which will also be available for free.

DSM is not mandatory for clinicians unless specifically required by their institutional settings (First, 2010). In fact, the ICD is the only classification system approved by HIPAA (Department of Health and Human Services, 2009) – not the DSM classification. As such, ICD codes meet all insurer-mandated and HIPAA coding requirements.

My advice- don’t buy DSM 5, don’t use it, don’t teach it.

References
American Counseling Association (ACA). (2011). 2011 statistics on mental health professions. Alexandria, VA: Author.
American Psychiatric Association (APA). (2011). American Psychiatric Association. Retrieved from http://www.psych.org/
American Psychological Association (APA). (2012). Support center: How many practicing psychologists are there in the United States? Retrieved fromhttp://www.apa.org/support/about/psych/numbers-us.aspx#answer
Center for Health Workforce Studies School of Public Health University at Albany. (2006). Licensed social workers in the United States, 2004. Available at http://workforce.socialworkers.org
Department of Health and Human Services. (2009). HIPAA administrative simplification: Modifications to medical data code set standards to adopt ICD-10-CM and ICD-10-PCS. 45 CFR Part 162. Federal Register 74, no. 11 3328-62. Available at http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf
First, M. B. (2010). Clinical utility in the revision of the diagnostic and statistical manual of mental disorders (DSM). Professional Psychology: Research and Practice, 41, 465-473.
Frances, A. J. (2012, November 13). You can’t turn a sow’s ear into a silk purse. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/blog/frances/content/article/10168/2099456#
Jones, K. D. (2012). A critique of the DSM-5 field trials. Journal of Nervous and Mental Disease, 200, 517-519.
Regier, D. (2012, April). DSM-5 Field Trials: Reliability of the Categorical Diagnoses. Presentation at the Annual Meeting of the American Psychiatric Association, Philadelphia, PA.

How to Recognize and Help an Addict

It’s devastating to know a friend or a loved one suffers from an addiction. Before people get help, they often go down a long road of addiction prior to anyone, including themselves, noticing a problem. Consider the information and advice below if you know or suspect someone is an addict.

Your Gut

Addicts are excellent liars. It can seem disheartening to hear that you shouldn’t take them at face-value. However, listen to your gut. Your gut is telling you that something is wrong. Do not ignore this. They will tell you all the right things you’d like to hear. They will go into detail about where they were, why they did something and more. Everything will sound right to your mind. The very fact that you feel something isn’t right means more than likely something truly isn’t. Listen to what they say, and take notes because if they are addicts, they will slip up eventually. Don’t be the big-bad wolf that’s out to get them, but don’t be an enabler either. Enablers help them to stay stuck in their addiction by making excuses for them.

Denial

Addicts especially high-functioning addicts think that if they’re able to go to work, bring money home, do housework and other normal day-to-day life they do not have a problem with addiction. An addict is not just the junkie on the corner. Most addicts are high-functioning, which means they go under the radar for what passes as an addict to society. Because of this, and for reasons such as not wanting to face themselves, addicts will lie to themselves and the world. This is why most addicts are in denial. They might also reason that they don’t drink “enough” to be an addict. Make no mistake that alcoholism isn’t about the quantity of alcohol ingested. It’s about the mental obsession and physical craving of alcohol that makes someone an alcoholic. People who don’t drink for three of four months and suddenly “binge” can be alcoholics.

Things Don’t Add Up

It is often said that addicts lead double lives. This is true for anyone living in dysfunction. To the outside world, they have it together. Underneath that façade is a broken human being who uses alcohol, substances or anything else to get by. To make matters worse, this outward appearance can be further covered up, or justified, with a prescription medication. Abuse of a prescription medication is a serious concern. People often overdose on their pills or makeup excuses for why they need them even though they don’t have a legitimate need for them. This is why centers offer painkiller addiction treatment because it is a common phenomenon. It is also a growing phenomenon.

Real Help

To the addict, you’re “mean,” “unreasonable,” and a few choice words when you confront them. Expect this upfront. It’s not a reflection of who you are as a person despite their best attempts to assassinate your character. What they say about you has everything to do with their dysfunction. More often than not, they will choose their addiction over you. Real help and real love mean saying, “I’m going to tell you the truth,” “I need to love myself before I can love you,” or “I don’t accept your excuse. You’re responsible for your behavior, and I refuse to be a part of your life until you take responsibility for yourself.”

You can’t force someone to get help, but you can stop enabling them. Don’t make excuses for their behaviors or addiction. Addicts have to want to get help before they do. Once you know there is a problem, stand your ground. Speak truthfully to the addict. Above all, love yourself because this has been and will continue to be incredibly hard on you. Understand that they have to learn to love themselves too.

How to Recognize and Help an Addict was last modified: March 8th, 2018 by Elliot Caleria

Veterans: Take This Survey!

Learning about military-to-civilian reintegration requires asking the right questions of the right people. A novel, new study is seeking military veteran respondents to learn more about the way service impacts health, civic engagement, and socio-economic outcomes for military-connected men and women. The data collected through this survey are expected to help us answer questions such as:

• Do veterans feel welcome and interested in institutional service groups like the VA and informal groups like VSOs? Do those organizations serve their needs? How are prospective members welcomed and served?
• How does military service impact community involvement and political engagement?
• How does military service impact experiences on the job market (and is this effect conditioned by demographic factors?
• Does military service break the glass ceiling for service women?

The project was developed by an interdisciplinary research team with experience, training, and connections to the military community. Dr. Kyleanne Hunter is a Marine Corps Cobra pilot and political science researcher. Dr. Rebecca Best is an experienced security studies researcher with a focus on service women. Dr. Kate Hendricks Thomas is a public health researcher and Marine Corps veteran. Each has specific training in community-based, participatory research and is invested in filling current gaps in what we think we know about the transition from service member to civilian.

Is Counseling For You

Have you been in counseling or therapy? If not, have you ever hesitated in seeing a counselor, or wondered why you felt so wary? Studies show about 20-35% of Americans having attended some form of counseling and psychotherapy compared to approximately 80% of mental health professionals.

Believing that counseling and psychotherapy could be helpful for anyone in alleviating problems, improving relationships, and developing a more positive outlook toward life, a Journal for Human Services research study explores why some people attend counseling or therapy while others do not.

Researchers, Ed Neukrug, Mike Kalkbrenner, and Sandy Griffith wondered why it was that some people seemed readily to attend counseling while others hesitate or who don’t attend often to their own detriment. Their research on attendance in counseling of helping professionals and their upcoming research on attendance in counseling of the public in general offers a thoughtful analysis which will hopefully shed some light on this important concern.

After an exhaustive review of the literature, researchers independently looked at over 60 potential barriers to attendance in counseling and eventually reduced this number down to 32 specific items. Their research found three broad areas or reasons likely to affect individuals who tend to avoid counseling and therapy. They identified these areas as “Fit,” “Stigma,” and “Value” to reflect the areas they represent.

Factor 1: Fit

Fit has to do with one’s sense of comfort with being in counseling and whether one has the ability to trust the process of counseling will be beneficial. Some typical fit questions were related to whether a potential client believed a counselor would feel comfortable with the potential client’s sexuality, disability, or other aspects of the client’s identity. Other questions in this area assessed whether a potential client believed a counselor could understand him or her, was competent enough to deal with the client’s problem and could keep the client’s concerns confidential. In addition, other “fit” questions queried whether potential clients had a bad experience with a counselor in the past and if they thought they could find a counselor near to where they lived

Factor 2: Stigma

Stigma is the feeling of shame or embarrassment some people experience when they consider entering a counseling relationship. Some of the stigma questions highlighted whether a potential client believed their friends, family, peers, colleagues, or supervisors might view them negatively if they knew the individual was in counseling. Other questions focused on how some potential clients might consider themselves weak, embarrassed, or unstable if they were in counseling. Often, those with high scores on stigma believed others would judge them, and thus, they would feel badly if they were to enter counseling.

Factor 3: Value

Value is the perceived benefit or worth one believes he or she is receiving from attendance in counseling. Potential clients who would score high in this area often believed the financial cost of counseling was not worth its benefits. Participants in this category simply could not afford counseling or they didn’t have time for it. Many participants in this category believed counseling wasn’t necessary because problems usually resolve on their own, or that counseling was simply not an effective use of their time. These individuals simply did not embrace the counseling process because the financial costs in their mind are hard to justify over meeting basic needs and/or having to take time off from work.

Although some individuals cannot find a counselor to their liking, participants worried whether counseling would be worthwhile, or they were ashamed or embarrassed about going to counseling. Most people believe that when faced with difficult life problems, counseling could be helpful.

It is hoped through research like this, people can better understand why they might be hesitant to seek a counselor and maybe overcome some of their fears. Additionally, this research can help national organizations, in the helping fields, find ways to help clients overcome these barriers.

Is Counseling For You was last modified: February 18th, 2018 by Edward Neukrug

Turnkey: A Co-Housing Experience in an Italian Public Service for Addiction

Turnkey is a term used in the economic field, but it also fits well in a social rehab project. The idea comes from the need to give some answers to the problem of those patients that experienced a long term therapy in an addiction rehab center for 3 or 4 years.

In the Italian welfare system, the outpatient service team -work (doctor, psychologist, educator, nurse and social worker), operating in the addiction recovery can schedule long term treatment in the residential rehab centers. In some cases, this long time permanence is something obliged, because of the serious addiction and also for the lack of different life perspectives after the recovery.

These kinds of patients need moretherapeutic help in order to return to civil society in order to find meaningful social membership. Usually, these clients have no meaningful familiar connections, no job, and no significant friendship.

In the last years, our social services system has become more careful about the use of public money. They noticed social workers more equipped to provide therapeutic interventions using a holistic approach in order to spare economic resources. Social workers are more capable to assist patients in reaching a better life condition by using their abilities toward social integration.

The Project

Five years ago, the program’s director asked for the professional team to think about a solution for the rehabilitation of the” long term patients”.

I started wondering about the meaning of poverty which is not only economics but it also the satisfaction of primary needs. It’s the lack of healthy relational bonds which weakness a lot the patients coming out of the drug addiction recovery programs.

I also noticed that this relational deficiency is a modern human condition; in the weakest social situations the loneliness is something that “destroys the mind “.

So I got an idea: I proposed to my director to start thinking about a possible apartment for a temporary co-housing for at least two patients.

He liked the project and submitted the plan to the municipalities which have the competence in the social side of rehabilitation. The municipalities agreed to the project and financed it.

For the patients in long term recovery, the rent was paid through the financing with the municipalities (an average of 6.000 Euro a year for 4 years, renewable), whereas the utilities and the others cost of the house has been in charge to the occupants.

The management of activities like the admission of the patients, the guaranteed respect of the therapeutic contract, the check of daily life and the help in the money administration, are some of my specific competences as a social worker.

In my job role, I had asignificant part into find fitting persons for the project who were able to live together. I also contributed to choosing the people eligible to live in that specific therapeutic situation.

I helped the patients to organize their new life and to establish minimum rules of mutual life in the apartment. The project is strictly tied to the learning of the skills required to come back to live a regular life.

For example:

– living together is an opportunity for the patients to learn mutual respect

-cleaning the home and paying the utilities is a way to come back to daily responsibility and autonomy.

– having a good neighborhood relationship is a way to learn again to have good relationships without drug addiction to interfered an apartment, next to the main social and sanitary services of the town.

The results

Since 2011, we housed 11 clients in the apartment with an average of one year placement. We should consider that one year in a residential rehab center cost 30.000 euro each person.

Eight of them returned was able to manage a regular social life, their addiction, a job, maintain social relationships which helped them to achieve a dignified lifestyle.

Two persons are still in the co-housing situation, one of them has a regular job, and he is searching for an own house. Only one person abandoned the treatment.

This intervention is a daily challenge for our team; it gave us good results in the recovery outcomes like independence, citizenship, struggle against the stigma and improvement of personal resources.

We also have spared a significant amount of public money while offering to our clients a higher quality of life.

The creativity and the professional skills mixed together with the help of other colleagues in the multidisciplinary teamwork made this project an effective strategy to help patients overcome their circumstances.

So, I can call myself a responsible social worker, because I help to improve the personal resources in my client’s life. I was mostly inspired from the basic professional principle “start from where the client is”.

Turnkey: A Co-Housing Experience in an Italian Public Service for Addiction was last modified: January 25th, 2018 by Rosita Mazzi

Will Veteran Suicide and Mental Illness Rate Improve?

Even in Afghanistan, I will seek pet therapy! – Rick Rogers (pictured above)

It was about 9 years ago. I decided to put down the rifle and pick up the DSM. You see, I was an infantryman since I was age 17. That means, since I was a child, I was literally trained to kill people. Looking back at it, that sounds like a profound concept.

I am proud of my time in the military. I am proud of my brothers and sisters who have ever answered the call. But… I am also worried.

As I said, 9 years ago, I decided to change my path. I didn’t realize where that path would lead. I seen multiple traumas and death happen to my fellow comrades. I went through some trauma myself, but I still worried about others more than myself. So, I decided to become a Mental Health Specialist in the military.

It’s been a long road going from Infantryman to Social Worker. There are a lot of learned attitudes and behaviors I had to change. Can you believe it? I literally had to learn empathy. And that took a long time.

Just about anyone in the military knows that drinking alcohol is a part of the lifestyle. Everyone I looked up to drank and considered me a p**sy if I didn’t. So… when I was sent to Germany back in the early 2000’s as a 19 year old kid, you better believe I drank. It was legal!

Looking back at my adventures between then and now, I don’t regret a thing. Yes, there were many embarrassing moments, and I have lost many friends along the way. I also met some great people. My alcohol use made my path rockier than anything else.

Many others have had this experience as well. Between 1998 and 2008, binge drinking went from 35% to 47% of veterans, and 27% of that 47% experienced combat.

Between 2002 and 2008, misuse of opiate prescriptions went from 2 percent to 11 percent in the military. These prescriptions were mostly due to injuries sustained in combat, as well as the strain of carrying heavy equipment.

This concerns me. When I was young, I had a good time. Looking back, maybe it wasn’t.This might not be every veteran’s experience, but the culture encouraged substance use and discouraged getting help. There are others that would agree with me.

This could explain why 20 veterans a day on average commit suicide. This is actually down from 22 a day before the 2014 study from the VA. However, it is a 32% increase since 2001. In 2014, veteran suicides accounted for 8.5% of U.S.’s adult suicides, and the rates were especially high among 19-29 year old compared to the older generation.

Let’s not forget about the infamy of PTSD. Up to twenty percent of veterans have suffered from this. Of course, those who suffer are more likely to admit their distress to a computer program than a battle buddy or their superior. This, again, goes with the constant culture that causes our military to fear judgment.

These wars have been a constant the last two decades, and have cost all U.S. citizens a pretty penny. According to one report, the VA spends $59 billion a year on health care. This number is 3 times as much as it was since before 2002.

And let’s not forget the cost this country has incurred for being in war for this long. Well, we don’t really know an exact number. The cost is estimated by many to be in the billions or even trillions. This isn’t including the interest from borrowed money.

So, after looking at all these figures, I am overwhelmed. How can I even make a dent in helping our nation’s veterans? The current administration is planning on increasing our presence in war zones. I am expecting the rate of PTSD and suicide to increase once again. Also, our country will continue to spend. It seems to me that we are all participating in a death and mental illness factory. The thing is, I didn’t even get to the physical injuries many of our combatants have suffered from.

I love our nation’s military. I want every one of them to know that I am here to support them. But most of all, we all need to be here to support each other.

Will Veteran Suicide and Mental Illness Rate Improve? was last modified: January 21st, 2018 by Rick Rodgers

First Responders: Behind The Festive Season

I’m a social worker. I’m a first responder spouse. With my partner, I advocate for improved mental health for first responders, including educating helping professionals to understand the culture, lifestyle, and demands of the job on both responders and their families.

I hear stories from police, paramedics, firefighters and frontline rescue responders and their family members every day. Tales of trauma, grief, and horror – and on the flip side incredible strength, resilience, courage and sacrifice. It’s December and social media is full of excited conversations about planned gatherings and festivities for Christmas and the New Year. Those posts inspire this reminder.

In Australia, there will be barbeques and beer in sweltering heat by the pool or at the beach, a stark contrast to some of our global friends whose Christmas will be white, accompanied by outdoor play with snowmen and gift giving inside by the warmth of a log fire.

Despite the contrast in temperatures across the globe, there are those who work tirelessly behind the scenes of Christmas beer and New Year cheer. Police, paramedics, firefighters, and rescue personnel are unlikely to experience the festive season in the way most people do. They are on call to ensure the public’s continued safety, health and wellbeing. And so their festive season, regardless of location, is far more likely to include these scenarios:

Burglary, elderly occupant assaulted and taken to hospital

Multiple occasions of drug overdose at a teenage party, several individuals taken to hospital in serious condition

Alcohol fuelled violence, multiple serious injuries

Bush fire endangering properties, implement evacuation procedures

Car accident, children seriously injured

House fire, no injuries but the house is beyond repair and a family is left homeless

Notification of the sudden death of someone’s loved one

This is a typical “festive season” for first responders. Their families are at home – not with their loved ones as is traditional, but quietly accepting that their loved one is needed out in the community to keep others safe. Some days will simply be a bit lonely, other days will be filled with concern for their safety.

For many first responders, the festive season brings back memories of trauma past. That makes the lead in time to end December a difficult one, rather than one of anticipatory excitement. And then, of course, we have those who can no longer turn out because of physical or psychological injury. Their lives forever changed by the job. Perhaps this year they do get to sit with their families and share a meal, but at a huge emotional and financial cost inflicted by their injuries.

Finally, a harsh reality in first responder world: the first responder family members who tragically have to face this “festive” season alone. This time not by choice. Their first responder’s life either taken away by an incident on the job or by a sense of hopelessness all too common in those with psychological injuries.

The festive season of giving is a timely reminder that we as a global community are exceptionally fortunate to have first responders looking after us. Whether you’re in Australia, India, Alaska or England, these people give up their precious family time to keep us safe. Many are volunteers. They are human, just like us. Witnessing human suffering is hard at any time – but this time of year adds extra burdens. Please drive carefully, celebrate carefully. And while we all sit in the protected bubbles of our own private Christmas and New Year celebrations- please spare a thought for all frontline responders and their families

In the spirit of the season, please acknowledge their sacrifice with a note, a smile, a thank you – so that in the midst of whatever trauma they’re dealing with, they will be reminded of the true intention of these times: goodwill, human connection, and hope.

First Responders: Behind The Festive Season was last modified: December 23rd, 2017 by Veronique Moseley